Neurocirugía
2008; 19: 356-360
Anterior third ventricle meningiomas. Report of two cases
E.R. Uygur; B. Deniz and K. Zafer
Ministry of Health Dışkapı Education and Research Hospital. Second Neurosurgery Clinic. Ankara. Turkey
Summary
Third ventricle meningiomas are rare, representing
approximately 0,15% of all meningiomas. The majority
of third ventricular meningiomas are located poste-
riorly in the pineal region. Less commonly, they arise
in the anterior part of the third ventricle. We report the
cases of two patients with large and giant meningiomas
originating in the anterior part of the third ventricle.
KEY WORDS: Meningioma. Intraventricular tumor. Third
ventricle
Meningiomas del tercer ventrículo. Presentación de dos
casos
Resumen
Los meningiomas del tercer ventrículo son raros.
Representan, aproximadamente, el 0,15% de todos los
meningiomas. La mayoría de los meningiomas del tercer
ventrículo se localizan en la parte posterior, en la región
pineal. Menos frecuentemente se originan en la parte
anterior del tercer ventrículo. Presentamos los casos de
dos pacientes con meningiomas grandes y gigantes, con
origen en la parte anterior del tercer ventrículo.
PALABRAS CLAVE: Meningioma. Tumor intraventricu-
lar. Tercer ventrículo.
Meningiomas comprise 13-18% of all intracranial
tumors; intraventricular meningiomas constitute 0,5-5,0%
of all meningiomas8,19,21,22. The majority of intraventricular
meningiomas are found in the trigone of the lateral ventri-
cle, predominantly on the left side4. Those meningiomas
arising in the third ventricle are rare, approximately
0,15% of all meningiomas3,6,18, and are usually located
posteriorly in the pineal region6,14,17. Less commonly, third
ventricle meningiomas arise in the anterior part of the
Recibido: 25-08-07- Aceptado: 2-10-07
356
third ventricle6,15. We report two cases with large and giant
meningiomas originating in the anterior part of the third
ventricle and discuss the differential diagnosis and treat-
ment options of this rare tumor.
Case 1
A 25-year-old woman was admitted with a three month
history of headache and almost three weeks of left sided
weaknes. Neurological examination disclosed papilledema,
4/5 left hemiparesis, and left hemihypesthesia. Magnetic
resonance (MR) imaging of the brain demonstrated an
homogeneously enhancing midline mass within the third
ventricle causing hydrocephalus (Figure 1 a,b). The tumor,
which was adherent to the anterior portion of the third
ventricle, was removed near totally via an interhemispheric
transcallosal approach (Figure 2 a,b). Postoperative course
was uneventful. Pathological examination revealed a psam-
momatous meningioma.
Case 2
A 25-year-old woman was admitted with a four month
history of headache and diplopia on right lateral gaze, and
one week of vomiting. Neurological examination disclosed
only papilledema. MR imaging of the brain demonstra-
ted an homogeneously enhancing third ventricular mass
(Figure 3 a,b). A right sided transcortical transventricular
approach to the third ventricle was performed. The tumor
was near totally removed (Figure 4 a,b). Postoperative
course was uneventful. Pathological examination revealed
a meningothelial meningioma.
Discussion
An heterogeneous group of lesions can be found in the
third ventricle and a variety of neoplasms can occur within
it. Astrocytomas, germinomas, craniopharyngiomas, chro-
roid plexus papillomas, teratomas, ependymomas and
colloid cysts can appear in this location20. Most of these
tumors are located much more frequently in the anterior
 Neurocirugía
Anterior third ventricle meningiomas. Report of two cases 2008 19: 356-360

a a

b b
Figure 1. Preoperative axial (a) and coronal (b) T1-weig-
hted contrast-enhanced MRI scans of case 1. The mass,
filling the IIIrd ventricle, is well demarcated and shows
solid, homogeneous enhancement.
part of the third ventricle compared with the posterior
part20. However, meningiomas are more commonly found
posteriorly6,9,14,17,18. Tumor location, age of the patient and
imaging characteristics can help the differential diagno-
sis20.
Figure 2. Postoperative axial (a) and coronal (b) T1-weig-
hted contrast-enhanced MRI scans of case 1. Approxima-
tely 8x6 mm of residual contrast-enhancement is seen.
Third ventricle meningiomas arise from the stroma
of the choroid plexus or from the tela choroidea which
together constitute the membrana tectoria3,8,14,17,18. The pre-
sence of arachnoid cell nests in the normal choroid plexus
stroma has been illustrated in the literature and a thorough
examination of the choroid plexus usually reveals small

357
 Neurocirugía
Uygur and col 2008; 19: 356-360

a a

b Figure 4. Postoperative contrast-enhanced axial (a) and
Figure 3. Preoperative unenhanced axial (a) and contrast-
enhanced coronal (b) T1-weighted MRI scans of case 2.
Well demarcated, 2,5x3x3 cm. mass in the IIIrd ventricle
is seen. The mass enhanced intensely after gadolinium
administration.
or sometimes larger collections of these cells4. In the 7th
to 9th gestational weeks, the telencephalic choroid plexus
has started to develop a loose mesenchymal stroma, which
is covered by a layer of cells derived from the ependyma.
b
coronal (b) T1-weighted MRI of case 2. A 6x6 mm. mini-
mally enhanced residual lesion is seen.
Arachnoid tissue is transported together with the choroid
plexus as the ventricular system invaginates, and by 20 to
40 weeks, the central stroma of the choroid plexus con-
tains meningocytes, connective tissue, and blood vessels.
In a similar fashion, intraventricular meningiomas arise
from arachnoid cells contained within the choroid plexus.
Meningothelial inclusion bodies are normally found in the
arachnoid and choroidal tela, and meningiomas arise from

358

Anterior third ventricle meningiomas. Report of two cases
this mesenchymal stroma of the choroid plexus4. These
tumors receive their blood supply from the medial posterior
choroidal arteries8,14. Third ventricle meningiomas which
constitute 0.15% of all meningiomas3,6,18 are more frequent
in children and adolescents8,16. In general, intraventricular
meningiomas predominate in females, but third ventricular
meningiomas are more common in males3,4,8,9,14,22. They
have been encountered in patients between 3-53 years of
age, with a peak incidence in the second decade3,8. In von
Recklinghausen’s disease the incidence of intraventricular
meningiomas is 16.6% and several cases of meningioma
of the third ventricle are reported3,4,15. The majority of the
third ventricle meningiomas are fibroblastic, syncytial or
of mixed type3,6,9,10,11. An atypical meningioma in a 6-year-
old boy12, a transitional meningioma in a 5-year-old girl7,
a psammomatous meningioma in a 7-year-old boy3 and a
malignant meningioma in a 61-year-old woman19 are repor-
ted in the literature.
Third ventricular meningiomas commonly present with
signs and symptoms of increased intracranial pressure
from hydrocephalus without any localizing neurological
sign1,3,4,6,8,17,18. Posterior third ventricular meningiomas
present as pineal masses with Parinaud’s syndrome3,17,18. A
case of anterior third ventricle meningioma without signs
or symptoms of increased intracranial pressure is also
reported5. Headache, vomiting, visual disturbances, ataxia,
tremor, Parkinson like syndrome, endocrine abnormalities1,
epilepsy, akinesia, poliuria, polidypsia and narcoleptic sei-
zures are reported with anterior third ventricle meningio-
mas3,12,17,18,22.
Third ventricle meningiomas are hyperdense lesions
on computerized tomography (CT). MR imaging usually
demonstrates an hypointense to isointense lesion on T1,
and isointense to hyperintense lesion on T2-weighted
images. Typically, these neoplasms brightly enhance with
contrast administration on CT or MRI17,20.
Total removal of third ventricle meningiomas can
be achieved through interhemispheric transcallosal or
transcortical transventricular approaches3,4,6,17,18,19,22. Trans-
cortical transventricular approach requires cortical inci-
sion to reach the lateral ventricle. This approach is best
used for lesions with a significant intravenricular com-
ponent within the third ventricle and associated enlarged
lateral ventricles. The most frequent complication of this
approach is the occurrence of postoperative seizures in a
frequency that has been reported to be as high as 27%2,
presumably as a result of the cortical incision which creates
an epileptogenic focus. Neurological deficits and memory
loss have also been reported following transcortical trans-
ventricular approach to the anterior third ventricle2. Finally,
if the lateral ventricles are large, drainage of the ventricles
through the cortical incision can lead to cortical collapse
and subdural fluid collections.
Neurocirugía
2008 19: 356-360
The interhemispheric transcallosal approach permits
to enter the third ventricle without a cortical incision.
Ventriculomegaly is not a prerequisite for this approach.
Hemiparesis, mental status changes, memory disturbances,
confusion and mutism have been reported following this
approach2. Posterior transcallosal approach may be used
for posterior third ventricular meningiomas without any
major complication13,21. In our view, transcallosal approach
seems less traumatic and more straightforward independen-
tly of the surgeon’s habit.
Conclusion
Two cases of large meningiomas of the anterior third
ventricle, which were succesfully surgically removed, are
presented. Although its incidence is rare, a confined round
mass in the third ventricle revealed by CT or MRI, should
raise the suspicion of meningioma as one of the possible
diagnoses.
References
1. Albert, P.: Tumors and other space occupying lesions of
the anterior part of the third ventricle. Neurocirugía 1999; 10:
27-41
2. Apuzzo, M.L.J., Litofsky, N.S.: Surgery in and around
the Anterior Third Ventricle. In: Apuzzo MLJ (ed), Brain Sur-
gery, vol 1, New York: Churchill Livingstone, 1993. pp. 541-
579.
3. Avman, N., Dinçer, C.: Meningiomas of the third ventri-
cle. Acta Neurochir 1978;42: 217-224.
4. Bhatoe, H.S., Singh, P., Dutta, V.: Intraventricular
meningiomas: a clinicopathological study and review of the
literature. Neurosurg Focus 2006; 20(3): E9
5. Cabeduzo, J.M., Vaquero, J., García-de-Sola, R., Arei-
tio, E., Bravo, G.: Meningioma of the anterior part of the third
ventricle. Acta Neurochir (Wien) 1981;56: 219-231.
6. Castillo, R.G., Geise, A.W.: Meningioma of the third
ventricle. Surg Neurol 1985; 24: 525-528.
7. Costa, L.B., Vilela, M.D., Lemos, S.: Third ventricle
meningioma in a child: case report. Arq Neuropsiquiatr 2000;
58: 931-934.
8. Dağçınar, A., Elmacı, İ., Özgen, S., Bayri, Y., Özek,
M.M., Pamir, M.N.: İntraventriküler meningiomlar. Türk
Nöroşir Derg 2000; 10: 144-150.
9. Dinc, C., Iplikçioglu, A.C., Cakabay, M., Tufan, A.,
Kosdere, S.: Third ventricle meningioma Journal of Neurolo-
gical Sciences (Turkish) 2005; 22: 089-093.
10. Gabriel, I.: Meningioma of the anterior part of the third
ventricle. Clinical case. Neurochirurgie 1995; 41: 120-123.
11. Gelabert, G.M., Fernández, F.M.A., Bollar, Z.A.,
García, A.A., Martínez, R.R.: Meningioma of the third ventri-
cle. Presentation of a case. Arch Neurobiol (Madrid) 1989; 52:
359

Uygur and col
100-104.
12. Huang, P.P., Doyle, W.K., Abbott, I.R.: Atypical
meningioma of the third ventricle in a 6-year-old boy. Neuro-
surgery 1993; 33: 312-315.
13. Kasowski, H., Piepmeier, J.: Transcallosal approach
for tumors of the lateral and third ventricles. Neurosurg Focus
June 2001;10: 1-5.
14. Markwalder, T.M., Markwalder, R.V., Markwalder,
H.M.: Meningioma of the anterior part of the third ventricle. J
Neurosurg 1979; 50: 233-235.
15. Pandya, P., Cyhisti, K., Bannister, C.M.: A third
ventricular meningioma in a child. Br J Neurosurg 1990; 4:
129-133.
16. Pau, A., Dorcaratto, A., Pisani, R.: Third ventricular
meningiomas of infancy. A case report. Pathologica 1996; 88:
204-206.
17. Renfro, M., Delashaw, J.B., Peters, K., Rhoton, M.D.:
Anterior third ventricle meningioma in an adolescent: A case
report. Neurosurgery 1992; 31: 746-750.
18. Sayette, V., Rivaton, F., Chapon, F., Hubert, P., Ganem,
F., Houtteville, J.P.: Meningioma of the third ventricle. Neuro-
360
Neurocirugía
2008; 19: 356-360
radiology 1991; 33: 354-356.
19. Strenger, S.W., Huang, Y.P., Sachdev, V.P.: Malignant
meningioma within the third ventricle: A case report. Neuro-
surgery 1987; 20: 465-468.
20. Suh, D.Y., Mapstone, T.: Pediatric supratentorial
intraventricular tumors. Neurosurg Focus June 2001; 10: 6-14.
21. Tahsin, E., Gocer, A.I., Seyda, E., Boyar, B,, Haci-
yakupoglu, S., Zorludemir, S.: Intraventricular Meningiomas:
A review of the literature and report of 8 cases. Neurosurgery
Quarterly Sep 2004; 14: 154-160.
22. Wakai, S., Nakamura, K., Niizaki, K., Nagai, M., Nis-
hizawa, T., Yokoyama, S., Kalayama, G.: Meningioma of the
anterior third ventricle presenting with parkinsonizm. Surg
Neurol 1984; 21: 88-92.
Uygur, E.R.; Deniz, B.; Zafer, K.: Anterior third ventricle
meningiomas. Report of two cases. Neurocirugía 2008; 19:
356-360.
Corresponding author: Uygur ER. Sogütözü Caddesi, 4. Sokak,
No: 22/7, 06510, Ankara, Turkey.